Surgeons deliver virtual temporal bone dissection course for otolaryngology residents, physicians

Two surgeons from Central Ohio recently traveled to Nicaragua on a humanitarian mission to treat children with serious ear, nose and throat conditions. However, this year they brought along some help in the form of high-tech equipment designed to appeal to a generation that grew up playing video games - not to entertain the children, but to train the local doctors and medical students.

Drs. D. Richard Kang and Gregory Wiet, pediatric otolaryngologists from Nationwide Children's Hospital and The Ohio State University (OSU), visited Escuela Hospital Antonio Lenin Fonseca in Managua, Nicaragua, in January. This was their fourth annual trip to the facility, which serves as the country's focal point for medical and surgical training.

Upon arrival, the two surgeons conducted their typical schedule of a day of outpatient evaluation, followed by several days of delicate surgeries, including airway and middle ear procedures. In addition, they provided training to otolaryngology residents and attending physicians, through both lectures and the surgical procedures they performed.

The unique aspect to this year's visit, however, was Kang and Wiet's presentation of a "virtual temporal bone dissection" course. Participants were trained on the unique Virtual Temporal Bone surgery simulation system, developed at Nationwide and OSU in conjunction with the Ohio Supercomputer Center (OSC), through funding from the National Institutes of Health (RO1-DC006458).

"The system creates real-time, interactive computer simulations for surgeons to learn the difficult and delicate surgical techniques associated with ear surgery, which involves drilling into a bone in the skull called the temporal bone," explained Don Stredney, senior research scientist for biomedical applications at OSC, whose team helped develop the simulation. "Because the temporal bone lies close to a major artery and critical nerves for the face, learning to perform the surgery can be tricky."

Without a virtual simulation environment, medical residents would learn this surgery by working on cadavers and through apprenticeships in an operating room. Through multi-institution validation studies, Stredney and Wiet believe that this simulation technology will increase the efficiency of a resident's training while also raising his or her proficiency. Ultimately, they assert, this innovation could provide a safe, cost-effective way to provide students with experience in the early stages of developing surgical technique.

The system makes use of a laptop computer with powerful graphics processing capability and a "haptic device," which provides force feedback. This feature simulates for the surgical trainee the feel of the drill interacting with the temporal bone, the portion of the skull just behind the temples and above the ear.

"With this type of training, surgeons are not only learning with their eyes, but also with their sense of touch," noted Wiet. "This could be an important tool in the learning process for surgeons to develop all their senses in order to guide their surgery."

A pilot phase of the system received the prestigious "Dr. Frank H. Netter Award for Special Contributions to Medical Education" from the Vesalius Trust for Visual Communication in Health Sciences in 2008. The award recognizes "the person or persons who have recently developed visually oriented educational materials with either proven or potential impact on the way health sciences are taught and/or practiced."

Kang and Wiet plan to continue to return to Nicaragua on a regular basis, not only to provide care for the population, but also to deliver training - including the virtual temporal bone dissection course - to the region's otolaryngology community to ensure long-term impact.

"This is an excellent example of how surgical simulation technology can greatly impact training in countries where traditional methods, such as using cadaveric material is not available," said Wiet. "It can give students life-like demonstrations before even turning over the knife."